Thursday, September 11, 2008

Cato Unbound features a typically fascinating essay, this time about creating a "Culture of Responsible Drug Use." Earth and Fire Erowid effectively argue that the notion of responsible drug use has as much relevance now as it does for an idealized post-prohibitionist future. Today, many, many Americans practice self-control regarding psychoactive substances, which are relatively easy for otherwise law-abiding citizens to obtain, especially if one includes legal "drugs," such as alcohol or caffeine. And no matter the endless shuffle of kids charged with "posession," who languish in the Juvenile Hall next to my school, or the bluster and spectacle of high-profile raids on marijuana dispensaries that cater to cancer patients. These shining examples of the DEA's good work (as well as its upcoming "Target America Campaign" which first takes aim at Los Angeles in October), do nothing to temper the reality that even the most socially isolated individual can gain access to the Internet and access to drugs, practically within same Charter Bundle Package. Simply typing in "Amsterdam" and "marijuana," allows one to quickly identify some foreign cannabis collective. The consumer can then immediately mail some cash in a inconspicuous birthday card labelled "To Grandma Adelheit," while waiting around for Ganesha's Dream to arrive.

In 2007, 42% of 12th-graders admitted to having used marijuana, according to a NIH study. When we speak about legalizing responsible drug use, high schoolers are not even our intended demographic. Yet most of these burgeoning adults somehow learn to consider the pros and cons of illicit substances, and end up figuring out how to monitor, or eventually terminate, their intake.

The Erowids' essay, however, never fully touches on the concept of addiction, slowly diminishing self-control, and the subsequent ramifications concerning personal autonomy. Most libertarians would argue that people have the right to decide whether or not use drugs, and to accept the responsibility for drugs' potential risks. But what if, after that first hit, the brain down-grades its stock of pleasure receptors? And if, just a few hits later, the desperate remaining receptors recognize the brain's waning neurohormone activity, and subsequently beg for a spare neurotransmitter to please, please come their way? With enough inconsolable pleading, the person may feel no other option than to "shut up" the receptors by acquiescing to their demands, and taking yet another hit.

Numerous experiments have shown that mice, once introduced to cocaine, will scamper toward the mesolimbic reward impostor instead of food, even if such behavior leads to the mice suffering from starvation and increasingly dangerous electric shocks. Without its first dabble in drugs, the mouse's addiction would have forever remained an unknown potential- a series of dormant nucleotides scripted in his genetic code, never to be unleashed by specific transcription factors. Certain mice, as well as people, may fall on the extreme right of the "genetic susceptibility to addiction" bell curve. However, one is never actually dedicated to a substance, just a chemical compound like any other, before the substance has been properly introduced to the brain.

Thus, what if obtaining that first high constitutes an "original sin" which slowly progresses to a nightmarish path of diminishing self-control, yet increasing physiological and social consequences? Are addicts simply suffering the effects of a single choice made that first day? The frontal cortex, or decision-making part of the brain, eventually starts to play virtually no role in the junkie's mind regarding drug use. This helps explain the abysmal long-term recovery rates for users, even those who attended fancy treatment centers. When it is neurologically proven that someone has lost self-control over addiction, should they still retain the personal autonomy associated with drug use?

Of course, these issues do not apply to certain drugs. It seems unconvincing that marijuana is addictive altogether. Additionally, the activity of the "partial agonist" group of opioids eventually approaches an asymptotic limit in its potential activity. By inhabiting the receptors of more powerful drugs, partial agonists prevent the development of increasing tolerance. It is difficult to determine the merits of banning such substances.

Perhaps better research, as well as screening for genetic risk factors of addiction will enhance people's abilities to become responsible decision-makers regarding narcotics. We know that D1-receptor deficient "knockout mice" refuse to partake in cocaine's pleasures, a fact that may have useful applications for people with a family history of addiction.

Despite the limitations of personal autonomy in reference to drug addiction, it does not necessarily follow that the government has the right to prevent potential addictions by banning controlled substances, nor that prohibiting such substances actually reduces addiction rates. Most advocates of minimum central authority believe that, in general, government failures stem from its relative inferiority compared to an aggregate of rational actors, producing, consuming, and consorting in ways that reflect individuals' personal priorities and rational self-interests.

However, in the case of addictive drugs, it is very difficult to determine when rational self-interest ends, and a drug's potentially freakish domination begins. While this does not mean that the government should intervene, it does impose on libertarians the concept that villains can indeed be of our own making. Whenever we reduce the impositions of government, we add to the moral burden and responsibility to be beared and voluntarily fulfilled by caring family and friends.

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About Me

I am a medical student in California. Disclaimer: I take patient privacy very seriously. When I talk about a 22-year-old, 5"5, 125 lb. African-American female with juvenile rheumatoid arthritis, please understand that my real patient might be a 65-year-old, 6"2, 220 lb. Caucasian patient with lung cancer. In other words, I have completely distorted the facts about my patients, and sometimes even completely made up stories. Additionally, I am not a licensed physician, and you should trust your grandma's shaman for medical advice before you trust this blog.